de Quervain’s Tenosynovitis

Abstract

de Quervain’s tenosynovitis is caused by inflammation and swelling of the tendons of the abductor pollicis longus and extensor pollicis brevis tendons at the level of the radial styloid process. This painful condition occurs most commonly between the ages of 30 and 50. It occurs more frequently in women. It is usually the result of trauma to the tendon from repetitive twisting motions. This condition is often associated with inflammatory arthritis including rheumatoid arthritis. There is also an association with pregnancy and baby care as lifting an infant requires using the thumbs for leverage. If the inflammation and swelling become chronic, the tendon sheath thickens, resulting in its constriction. A triggering phenomenon may occur, with the tendon catching within the sheath and causing the thumb to lock, or “trigger.” Arthritis and gout of the first metacarpal joint may coexist with de Quervain’s tenosynovitis and exacerbate the associated pain and disability.

de Quervain’s tenosynovitis occurs in patients engaged in repetitive activities such as handshaking or high-torque wrist turning (e.g., when scooping ice cream). De Quervain’s tenosynovitis may also develop without obvious antecedent trauma.

The pain of de Quervain’s tenosynovitis is localized to the region of the radial styloid. It is constant and is made worse with active pinching activities of the thumb or ulnar deviation of the wrist. On physical examination, the patient has tenderness and swelling over the tendons and tendon sheaths along the distal radius, with point tenderness over the radial styloid. Many patients with de Quervain’s tenosynovitis note a creaking sensation with flexion and extension of the thumb. A catching or stop-and-go sensation may be present when moving the thumb. Range of motion of the thumb may be decreased by the pain, and a trigger thumb phenomenon may be noted. Patients with de Quervain’s tenosynovitis demonstrate a positive Finkelstein test result.

Keywords

de Quervain’s tenosynovitis, radial syloid, trigger thumb, trigger finger, Finkelstein test, wrist pain, arthritis, diagnostic sonography, ultrasound guided injection, cheiralgia paresthetica

ICD-10 CODE M65.4

Keywords

de Quervain’s tenosynovitis, radial syloid, trigger thumb, trigger finger, Finkelstein test, wrist pain, arthritis, diagnostic sonography, ultrasound guided injection, cheiralgia paresthetica

ICD-10 CODE M65.4

The Clinical Syndrome

de Quervain’s tenosynovitis is caused by inflammation and swelling of the tendons of the abductor pollicis longus and extensor pollicis brevis tendons at the level of the radial styloid process. This painful condition occurs most commonly between the ages of 30 and 50. It occurs more frequently in women. It is usually the result of trauma to the tendon from repetitive twisting motions. This condition is often associated with inflammatory arthritis including rheumatoid arthritis. There is also an association with pregnancy and baby care as lifting an infant requires using the thumbs for leverage. If the inflammation and swelling become chronic, the tendon sheath thickens, resulting in its constriction. A triggering phenomenon may occur, with the tendon catching within the sheath and causing the thumb to lock, or “trigger.” Arthritis and gout of the first metacarpal joint may coexist with de Quervain’s tenosynovitis and exacerbate the associated pain and disability.

de Quervain’s tenosynovitis occurs in patients engaged in repetitive activities such as handshaking or high-torque wrist turning (e.g., when scooping ice cream). De Quervain’s tenosynovitis may also develop without obvious antecedent trauma.

The pain of de Quervain’s tenosynovitis is localized to the region of the radial styloid. It is constant and is made worse with active pinching activities of the thumb or ulnar deviation of the wrist ( Fig. 52.1 ). Patients note an inability to hold a coffee cup or turn a screwdriver. Sleep disturbance is common.

Signs and Symptoms

On physical examination, the patient has tenderness and swelling over the tendons and tendon sheaths along the distal radius, with point tenderness over the radial styloid. Many patients with de Quervain’s tenosynovitis note a creaking sensation with flexion and extension of the thumb. A catching or stop-and-go sensation may be present when moving the thumb. Range of motion of the thumb may be decreased by the pain, and a trigger thumb phenomenon may be noted. Patients with de Quervain’s tenosynovitis demonstrate a positive Finkelstein test result ( Fig. 52.2 ). The Finkelstein test is performed by stabilizing the patient’s forearm, having the patient fully flex his or her thumb into the palm, and then actively forcing the wrist toward the ulna. Sudden severe pain is highly suggestive of de Quervain’s tenosynovitis.